This document discusses methods of hemorrhage control in the pre-hospital setting. Hemorrhage is the leading cause of preventable death in trauma. The document outlines signs of blood loss and sources of external and internal bleeding. It describes techniques for hemorrhage control including applying direct pressure, pressure dressings, and tourniquets. The goals of pre-hospital care are continuing hemorrhage control and rapid transport to a surgical facility to prevent patients from bleeding to death.

1. Hemorrhage ControlHemorrhage Control
An introduction to standard care

2. 22
IntroductionIntroduction
 Review methods of hemorrhage control inReview methods of hemorrhage control in
the pre-hospital setting.the pre-hospital setting.
 Hemorrhage is the leading cause ofHemorrhage is the leading cause of
preventable death in trauma.preventable death in trauma.
 Hemorrhage control save lives.Hemorrhage control save lives.

3. 33
Cardiovascular SystemCardiovascular System

4. 44
Blood VesselsBlood Vessels
 ArteriesArteries
 ArteriolesArterioles
 CapillariesCapillaries
 VenulesVenules
 VeinsVeins

5. 55
PulsesPulses
 Left ventricle contracts.Left ventricle contracts.
 Peripheral pulses:Peripheral pulses:
– RadialRadial
– BrachialBrachial
– Posterior tibialPosterior tibial
– Dorsalis pedisDorsalis pedis
 Central pulses:Central pulses:
– CarotidCarotid
– FemoralFemoral

6. 66
BloodBlood
 Adult body:Adult body:
– Contains approximately 5 to 6 liters of bloodContains approximately 5 to 6 liters of blood
– Loss of 1 pint of blood without harmful effectsLoss of 1 pint of blood without harmful effects
– Loss of 2 pints may cause shockLoss of 2 pints may cause shock
 Three phases ofThree phases of
hemostasis:hemostasis:
– Vascular spasmVascular spasm
– Platelet plug formationPlatelet plug formation
– Blood clottingBlood clotting
(coagulation cascade)(coagulation cascade)

7. 77
HemorrhageHemorrhage
 Pulse vs. Blood Pressure.Pulse vs. Blood Pressure.
 How long until there are changes?How long until there are changes?
 Young healthy adults compensate for longYoung healthy adults compensate for long
periods, then decompensate rapidly.periods, then decompensate rapidly.
 At what blood pressure do casualties loseAt what blood pressure do casualties lose
consciousness?consciousness?
─ @ 50 mm Hg@ 50 mm Hg

8. 88
Clinical Signs of Acute HemorrhageClinical Signs of Acute Hemorrhage
ClassClass % Blood% Blood
LossLoss
Clinical SignsClinical Signs
II Up to 750 mlUp to 750 ml
(15%)(15%)
Slight increase in HR; no change in BPSlight increase in HR; no change in BP
or respirationsor respirations
IIII 750-1500 ml750-1500 ml
(15-30%)(15-30%)
Increased HR and respirations;Increased HR and respirations;
increased diastolic BP; anxiety, fright orincreased diastolic BP; anxiety, fright or
hostilityhostility
IIIIII 1500-20001500-2000
ml (30-40%)ml (30-40%)
Increased HR and respirations; fall inIncreased HR and respirations; fall in
systolic BP; significantsystolic BP; significant AMSAMS
IVIV >2000>2000
(>40%)(>40%)
Severe tachycardia; severe lowering ofSevere tachycardia; severe lowering of
BP; cold, pale skin; severe AMSBP; cold, pale skin; severe AMS

9. 99
Sources of HemorrhageSources of Hemorrhage
 External:External:
– Visible blood is hard to estimateVisible blood is hard to estimate
 Internal:Internal:
– May be hidden within the torso or even inMay be hidden within the torso or even in
the extremities secondary to fracturesthe extremities secondary to fractures

10. 1010
Sources of External BleedingSources of External Bleeding
 Arterial:Arterial:
─Rapid, profuse and pulsatingRapid, profuse and pulsating
─Bright red in colorBright red in color
 Venous:Venous:
─Steady flowSteady flow
─Dark red or maroon in colorDark red or maroon in color
 Capillary:Capillary:
─Slow and oozingSlow and oozing
─Often clots spontaneouslyOften clots spontaneously

11. 1111
Extremity HemorrhageExtremity Hemorrhage
Click on picture for video

12. 1212
Internal Signs of HemorrhageInternal Signs of Hemorrhage
 Soft tissue bruising.Soft tissue bruising.
 Abdominal tenderness.Abdominal tenderness.
 Hemoptysis.Hemoptysis.
 Hematemesis.Hematemesis.
 Melena.Melena.

13. 1313
Injured Internal OrgansInjured Internal Organs

14. 1414
Hemorrhage ControlHemorrhage Control
 Expose the wound.Expose the wound.
 Attempt to control theAttempt to control the
bleeding with directbleeding with direct
pressure or a pressurepressure or a pressure
dressing.dressing.

15. 1515
Hemorrhage ControlHemorrhage Control
 Life-threatening arterial bleedingLife-threatening arterial bleeding
(amputation) may require early use of a(amputation) may require early use of a
tourniquet.tourniquet.
 If under enemy fire or in a dangerousIf under enemy fire or in a dangerous
position rapidly apply a tourniquet andposition rapidly apply a tourniquet and
move casualty to cover.move casualty to cover.

16. 1616
TourniquetsTourniquets
 Several new tourniquets have beenSeveral new tourniquets have been
selected as primary means to controlselected as primary means to control
hemorrhage in combat.hemorrhage in combat.

17. 1717
Improvised TourniquetImprovised Tourniquet
 Place cravat between heart and wound.Place cravat between heart and wound.
 Tie a half-knot on upper surface.Tie a half-knot on upper surface.
 Place a short stick on half-knot.Place a short stick on half-knot.
 Tie a square knot on top ofTie a square knot on top of
stick.stick.
 Twist stick (windlass) toTwist stick (windlass) to
tighten.tighten.
 UNTIL BLEEDING STOPS.UNTIL BLEEDING STOPS.
 Secure windlass to prevent unwinding.Secure windlass to prevent unwinding.

18. 1818
Improvised TourniquetImprovised Tourniquet

19. 1919
Tourniquet PrinciplesTourniquet Principles
 Never cover a tourniquet.Never cover a tourniquet.
 Never remove the tourniquet once placedNever remove the tourniquet once placed
unless directed by medical control.unless directed by medical control.
 Understand the tourniquets are painfulUnderstand the tourniquets are painful
and the patient may plead with you toand the patient may plead with you to
remove it.remove it.

20. 2020
AmputationAmputation
 Apply a pressure dressing to cover theApply a pressure dressing to cover the
end of the stump.end of the stump.
 Kerlix and 6” Ace wrap for effectiveKerlix and 6” Ace wrap for effective
pressure dressing.pressure dressing.
 Rinse amputated part free of debris.Rinse amputated part free of debris.
 Wrap loosely in saline-moistened sterileWrap loosely in saline-moistened sterile
gauze.gauze.

21. CMASTCMAST 2121
Preservation of Amputation PartsPreservation of Amputation Parts
 Seal amputated part in a plastic bag orSeal amputated part in a plastic bag or
cravat.cravat.
 Place in a cool container; do not allow toPlace in a cool container; do not allow to
freeze.freeze.
 Never place an amputated part in water.Never place an amputated part in water.
 Never place amputated part directly on ice.Never place amputated part directly on ice.
 Never use dry ice to cool an amputatedNever use dry ice to cool an amputated
part.part.

22. 2222
Treatment GoalsTreatment Goals
 Hemorrhage control continues to be theHemorrhage control continues to be the
priority in pre-hospital care.priority in pre-hospital care.
 Hemorrhage is the leading cause ofHemorrhage is the leading cause of
preventable death in trauma.preventable death in trauma.
 Our focus must be on stopping patientsOur focus must be on stopping patients
from bleeding to death, and rapidfrom bleeding to death, and rapid
transport to a surgical facility.transport to a surgical facility.

23. THANK YOU!THANK YOU!